1. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Current Status of ART Opportunities & Challenges Kibrebeal Melaku,MD Associate Professor of Medicine December, 2005

2. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Current Status of ART in Ethiopia: Opportunities & Challenges l Ethiopia is one of sub-Saharan countries hard hit by the HIV pandemic. According to the 2005 projection of Federal Ministry of Health’s Fifth reports of “AIDS in Ethiopia”, the HIV national adult prevalence rate is estimated to be 4.7%, of which 12.5% are urban and 3.0% rural. The cumulative number of people living with HIV/AIDS is about 1.7 million out of which more than 286,200 are AIDS cases in need of ART. How ever it is quite disturbing to note that there is still a huge gap between the number of patients eligible for ARV with the number of patients who are currently receiving HAART (286,200 Vs 21,200). l The Ethiopian government adapted the policy of ARV drug supply and use for the first time in July 2003.Such move paves the way for more initiatives towards facilitating access to free and low cost ARV drugs. Subsequently the government launched the free ARV treatment initiative in January 2005,which has given access to significant number of patients in a very short period of time. l In the following section, we will further discuss the current situation of ART in Ethiopia. The existing challenges and the available opportunities to scale up and expand the ART program will be discussed as well in depth.

3. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoObjectives l Provide an overview on the Current Status of ART Implementation in Ethiopia l To discuss on Opportunities and Challenges on implementing ART in Ethiopia

4. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Administrative Division

5. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info AIDS in Ethiopia, Fifth Edition l Number of adult PLWHA in 2003.......... 1.5 million l Number of adult PLWHA in 2004......... 1.6 million l People eligible for ARV drugs u In 2004…… …………….... 265,358

6. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Ethiopia’s Response l Developed ART Policies and ARV guidelines Trained ART providers ( ~ 800). Trained ART providers ( ~ 800). l Launched ART program (July 2003) l Physician-centered, Out-of pocket basis. Currently: ~ 21,200 patients are on ART Currently: ~ 21,200 patients are on ART ( ~ 6,200 – Free) ( Fee based - 15,000) ( Fee based - 15,000) u In 35 (25 public, 10 private) hospitals u In 7 regions u Total PLWHA are on ART

7. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info National Consensus l Strengthen and expand the National ART Program Goal: Implement safe, effective, equitable and accessible ART program while strengthening the health care system Goal: Implement safe, effective, equitable and accessible ART program while strengthening the health care system l Scaling-up efforts will be coordinated and integrated l Country partners: MOH, HAPCO, DACA, EHNRI, AAU Regional Health Bureaus, Private sector, Media, Facilities l Supported by USG partners, UN, WHO, Others.

8. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info ART Rollout Plan l PHASED Approach l FY ’ 04 - 05: u Free ART will be started in 20 Hospitals u Then will be expanded to  50 hospitals l FY’05 – ‘08: u 126 hospitals

9. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info ART ART Opportunities Challenges

10. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Challenges Technical & Programmatic

11. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoChallenges l Weak health systems l Competing National priorities on financial resources l Stigma - serious challenge l Supply Vs Demand - Eligibility

12. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoChallenges l Human resources: u MD, HO, RN, Pharmacy. P., Laboratory P. u Training – Standardization l Infrastructure: – Space, esp. pharmacy l Lab equipment and supply l Systems: HMIS, QC/QA

13. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoChallenges l Processes u Standardization – Services, Trainings u Integration - Coordination u Ownership: National, Regional, Facility u Strengthen Referral Linkages l Mechanisms of Procurement, Storage & Distribution – Assuring uninterrupted supply

14. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoChallenges l Long term Mx of Chronic Infection: u Practice Set-up u Monitoring Safety & Efficacy u Adherence - RESISTANCE “Site Readiness – Minimum Package” “Accreditation” l Sustainability - AIDS Fund

15. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoOpportunities

16. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoOpportunities 1. National Commitment u Strategic Plan & Management u ARV Policy, ARV Guidelines u ART Implementation Guideline l Provision of Safe & effective ART. l Capacity Building u Strengthen the health care delivery system

17. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoOpportunities 2- Access to care/ART: l Negotiations with the pharmaceuticals l Local Generic drug production

18. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.infoOpportunities 3- Global initiatives and opportunities: l PEPFAR [ETAEP] l GFATM l World Bank l Others

19. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info PEPFAR Targets l Treat more than 2 million with HAART l Prevent 7 million New Infections Care for 10 million HIV-infected persons and those orphaned by HIV Care for 10 million HIV-infected persons and those orphaned by HIV 2 - 7 - 10

20. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info PEPFAR Five Year Country Goals: ETHIOPIA

21. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info PEPFAR/ETAEP Support l Target: 15,000 patients on ART first year 20 hospitals 20 hospitals 80 health centers 80 health centers

22. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Global Fund (GFATM) Support Target: 20,000 patients first year 20 – 30 hospitals 20 – 30 hospitals 90 health centers 90 health centers

23. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Other ART Programs l MSF Holland l ENAHPA l Red Cross l RATSON

24. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Ingredients for Successful ART Program l Individual commitment to fight HIV l Total health professional commitment to treat HIV/AIDS l National commitment to curb the raging epidemic for the collective good l Political will to commit resources & efforts l Collective commitment to take care of people with HIV/AIDS with sensitivity and dignity

25. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info ART ART Challenges Opportunities

26. Downloaded from http://www.hiv-msd.infohttp://www.hiv-msd.info Then Power of ART will be Realized!